title: Predictive factors for improvement of ascites after transjugular intrahepatic portosystemic shunt in patients with refractory ascites.
abstract: OBJECTIVE
  The aim of this study was to investigate the predictive factors for the response of ascites to a transjugular intrahepatic portosystemic shunt (TIPS) and the impact of improvement of ascites on the overall prognosis of patients with cirrhosis and refractory ascites.
  
  
  METHODS
  Forty-seven consecutive patients with liver cirrhosis who underwent TIPS for refractory ascites were studied retrospectively. The mean follow-up period was 615 ± 566 days.
  
  
  RESULTS
  Thirty-six of the patients (77%) were responders at 4 weeks after TIPS (early responders) and 37 (79%) were responders at 8 weeks after TIPS. Of the 11 non-responders at 4 weeks, four showed an improvement of ascites at 8 weeks. Multivariate analysis showed that only the serum creatinine level before TIPS was an independent predictor of an early response. The cumulative survival rate of early responders was significantly higher than that of non-responders. The survival of patients grouped according to creatinine level was better in patients with serum creatinine of 1.9 mg/dL or less than in those with serum creatinine of more than 1.9 mg/dL.
  
  
  CONCLUSIONS
  A low serum creatinine level in patients with refractory ascites is associated with an early response to TIPS. An early response of ascites to TIPS provides better survival. A serum creatinine level below 1.9 mg/dL is required for a good response to TIPS.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Taki
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Narahara
authors.forename: Norio
authors.initials: N
authors.lastname: Itokawa
authors.forename: Chisa
authors.initials: C
authors.lastname: Kondo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fukuda
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Harimto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsushita
authors.forename: Hideko
authors.initials: H
authors.lastname: Kidokoro
authors.forename: Tamaki
authors.initials: T
authors.lastname: Katakura
authors.forename: Masanori
authors.initials: M
authors.lastname: Atsukawa
authors.forename: Yuu
authors.initials: Y
authors.lastname: Kimura
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Nakatsuka
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
keywords: complication; liver cirrhosis; portal hypertension; refractory ascites; transjugular intrahepatic portosystemic shunt